Metabolic Syndrome, Inflammation and Atherosclerosis

Figures & data

Table 1 Definitions of the metabolic syndrome

World Health Organization	NCEP ATPIII	International Diabetes Federation
At least one of the following criteria of insulin resistance and impaired glucose regulation	Abdominal obesity as defined by:	Central obesity defined as:
	waist circumference >102 cm in men	waist circumference ≥94 cm for Europid men
impaired FPG ≥110 mg/dL	waist circumference >88 cm in women	waist circumference ≥80 cm for Europid women
impaired PG tolerance (2h PG ≥140 mg/dL)	TG ≥ 150 mg/dL	with ethnicity specific values for other groups
elevated insulin levels (4th quartile of reference) diabetes	HDL-C in men <40 mg/dL, in women <50 mg/dL	Plus any two of the following four factors:
		raised TG level: ≥150 mg/dL (1.7 mmol/L), or specific treatment for this lipid abnormality
Plus two or more of the following:	BP ≥130/85 mm Hg
Systolic BP ≥140 mm Hg and/or diastolic	FPG ≥110 mg/dL	reduced HDL-C: <40 mg/dL (1.03 mmol/L) in males and <50 mg/dL (1.29 mmol/L) in females, or specific treatment for this lipid abnormality
BP ≥90 mm Hg
TG ≥150 mg/dL and/or HDL-C <35 mg/dL for men and <40 mg/dL for women
		raised BP: systolic BP ≥130 or diastolic BP
Central obesity: waist/hip ratio >0.90 for men and 0.85 for women and/or BMI >30 kg/m^2		≥85 mm Hg, or treatment of previously diagnosed hypertension
Microalbuminuria: urinary albumin excretion rate		raised FPG ≥100 mg/dL (5.6 mmol/L), or previously diagnosed type-2 diabetes
≥ 20 mg/ml or albumin/creatinine ratio ≥30 mg/g
		If above 5.6 mmol/L or 100 mg/dL, oral glucose tolerance test is strongly recommended but is not necessary to define presence of the syndrome.

Abbreviations: ATP, Adult Treatment Panel; BMI, body mass index; BP, blood pressure; FPG, fasting plasma glucose; HDL-C, high-density lipoprotein cholesterol; NCEP, National Cholesterol Education Program; PG, plasma glucose; TG, triglycerides.

Table 2 The inflammatory component of the metabolic syndrome

Vascular dysfunction
Endothelial dysfunction
Microalbuminuria
Proinflammatory state
Elevated hsCRP and SAA
Elevated inflammatory cytokines (TNF-α, IL-6)
Decreased adiponectin levels
Prothrombotic state
Increased antifibrinolytic factors (PAI-1)
Increased fibrinogen
Insulin resistance
Visceral adiposity

Abbreviations: hsCRP, high sensitivity C-reactive protein; IL-6, interleukin 6; PAI-1, plasminogen activator inhibitor 1; SAA, serum amyloid A; TNF-α, tumor necrosis factor-α.

Table 3 Current therapeutic approaches to the treatment of metabolic syndrome

Primary prevention
Healthy lifestyle promotion
Small weight loss
Moderate physical activity
Dietary restriction in calorie intake
Change in dietary composition
Drug intervention for treatment of individual components
Atherogenic dyslipidemia
Statins
Fibrates
Nicotinic acid
Elevated blood pressure
No particular agent is preferred, although ACE inhibitors and angiotensin receptor blockers may carry advantage in patients with metabolic disorders
Insulin resistance and hyperglycemia
Metformin
Thiazolidinediones
Acarbose
Orlistat

Abbreviations: ACE, angiotensin-converting enzyme.